+g Mathy D. Mezey, RN, EdD, FAAN, Series Editor New York University Division of Nursing Advisory Board: Margaret Dimond, PhD, RN, FAAN; Steven H. Ferris, Ph.D; Terry Fulmer, RN, PhD, FAAN; Linda Kaeser, PhD, RN, ACSW, FAAN; Virgene Kayser-Jones, PhD, RN, FAAN; Eugenia Siegler, MD; Neville E. Strumpf, PhD, RN, FAAN; May Wykle, PhD, RN, FAAN; Mary K. Walker, PhD, RN, FAAN 2004 Restorative Care Nursing for Older Adults: A Guide for All Care Settings Barbara Resnick, PhD, CRNP, FAAN, FAANP 2004 Care of Gastrointestinal Problems in the Older Adult Sue E. Meiner, EdD, APRN, EC, GNP 2003 Geriatric Nursing Protocols for Best Practice, 2nd ed. Mathy D. Mezey, EdD, RN, FAAN, Terry Fulmer, PhD, RN, FAAN, Ivo Abraham, PhD, RN, FAAN, De Anne Zwicker, Managing Editor, MA, APRN, BC 2002 Care of Arthritis in the Older Adult Ann Schmidt Luggen, PhD, RN, MSN, CS, BC-ARNP, and Sue E. Meiner, EdD, APRN, BC, GNP 2002 Prostate Cancer: Nursing Assessment, Management, and Care Meredith Wallace, PhD, RN, CS-ANP, andLorrieL. Powel, PhD, RN 2002 Bathing Without a Battle: Personal Care of Individuals With Dementia Ann Louise Barrick, PhD, Joanne Rader, RN, MN, FAAN, Beverly Hoeffer, DNSc, RN, FAAN, and Phillip D. Shane, MD, MPH 2001 Critical Care Nursing of the Elderly, Second Edition Terry Fulmer, PhD, RN, FAAN, Marquis D. Foreman, PhD, RN, FAAN, Mary Walker, PhD, RN, FAAN, and Kristen S. Montgomery, PhD, RNC, IBCLC 1999 Geriatric Nursing Protocols for Best Practice Ivo Abraham, PhD, RN, FAAN, Melissa M. Bottrell, MPH, Terry T. Fulmer, PhD, RN, FAAN, and Mathy D. Mezey, EdD, RN, FAAN 1998 Home Care for Older Adults: A Guide for Families and Other Caregivers—Text and Instructor's Manual/Lesson Plan Mary Ann Rosswurm, EdD, RN, CS, FAAN 1998 Restraint-Free Care: Individualized Approaches for Frail Elders Neville E. Strumpf, PhD, RN, C, FAAN, Joanne Patterson Robinson, PhD, RN, Joan Stockman Wagner, MSN, CRNP, and Lois Evans, DNSc, RN, FAAN 1996 Gerontology Review Guide for Nurses Elizabeth Chapman Shaid, RN, MSN, CRNP, andKayHuber, DEd, RN, CRNP 1995 Strengthening Geriatric Nursing Education Terry Fulmer, RN, PhD, FAAN, and Marianne Matzo, PhD, RN, CS 1994 Nurse-Physician Collaboration: Care of Adults and the Elderly Eugenia L. Siegler, MD, and Fay W. Whitney, PhD, RN, FAAN 1993 Health Assessment of the Older Individual, Second Edition Mathy D. Mezey, RN, EdD, FAAN, Louise H. Rauckhorst, RNC, ANP, EdD, and Shirlee Ann Stokes, RN, EdD, FAAN 1992 Critical Care Nursing of the Elderly Terry T. Fulmer, RN, PhD, FAAN, and Mary K. Walker, PhD, RN, FAAN About the Author Barbara Resnick, PhD, CRNP, FAAN, FAANP holds a B.S.N. from the Uni- versity of Connecticut, an M.S.N. from the University of Pennsylvania Geronto- logical Nurse Practitioner program, and a Ph.D. in Nursing from the University of Maryland. She maintains certification as a geriatric nurse practitioner from the American Nurses Credentialing Center. She is currently is an Associate Pro- fessor in the Department of Adult Health at the University of Maryland School of Nursing, and maintains a clinical/faculty position with clinical work at Roland Park Place, a Lifecare community. Dr. Resnick is a Fellow in the Amer- ican Academy of Nurse Practitioners, and the American Academy of Nursing. Dr. Resnick has over 100 articles published in nursing and/or medical jour- nals, and numerous chapters in nursing textbooks related to care of the older adult. She has also presented on these topics nationally and internationally. Dr. Resnick is currently on numerous Advisory Boards, including the Eastern Nursing Research Society, American Geriatrics Society, and Society of Behav- ioral Medicine. She is Chair of the Fellowship of the American Academy of Nurse Practitioners, Secretary of the American Academy of Nurse Practitioners 1996-2000, and Vice President Elect, President, and Past-President of the National Conference of Gerontological Nurse Practitioners 2001 to 2004. She serves on numerous other jour- nal advisory boards such as Caring for the Ages, ElderHealth, Advance for Nurses, and the Internet Journal of Geriatrics and Gerontology. Dr. Resnick also maintains an active clinical practice providing primary medical management to older adults in a variety of settings, and brings with her over 30 years of experience in long-term care. As a clinician she serves as a role model to other care providers working with older adults and strives to demonstrate innovative and exciting ways in which to motivate staff and older adults so that they can achieve their highest functional level, and main- tain optimal health and quality of life. Restorative Care Nursing for Older Adults A Guide for All Care Settings Barbara Resnick, PhD, CRNP, FAAN, FAANP Associate Professor, Univerity of Maryland School of Nursing Springer Publishing Company This book is dedicated to: my four children, Aliza, Elie, Jacob, and Yael; my husband Howard; my mother Maidie Resnick; two brothers Frank and Yale; sister-in-laws Judy Resnick and Amy Sollins; and in-laws Helen and Leonard Sollins for their support, encouragement and patience with me; to all the older adults who have taught me about the challenges associated with aging and the ways in which they overcome those challenges; and lastly, to my father who taught me never to say "I can't." Copyright © 2004 by Springer Publishing Company, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. Springer Publishing Company, Inc. 536 Broadway New York, NY 10012-3955 Cover design by: Joanne Honigman Acquisitions Editor: Ruth Chasek Production Editor: Janice Stangel 01 02 03 04 05/5 4321 Library of Congress Cataloging-in-Publication Data Restorative care nursing for older adults : a guide for all care settings / Barbara Resnick... [et al.]. p. ; cm. - (Springer series on geriatric nursing) Includes bibliographical references and index. ISBN 0-8261-2454-2 (alk. paper) 1. Geriatric nursing. 2. Rehabilitation nursing. 3. Older people—Rehabilitation. [DNLM: 1. Rehabilitation Nursing—methods-Aged. 2. Caregivers-education. 3. Recovery of Function-Aged. 4. Reimbursement Mechanisms. WY 152 R4356 2004] I. Resnick, Barbara. II. Series. RC954.R475 2004 618.97'023 l--dc22 2004013002 Printed in the United States of America by Integrated Book Technology Contents List of Tables and Figures vii Contributors ix Preface xi xi 1. Overview of Restorative Care 1 Barbara Resnick and Robin E. Remsburg 2. Staff Education and Motivation: Establishing the Restorative Care Philosophy 13 Barbara Resnick and Marjorie Simpson 3. Evaluating the Older Adult for Restorative Care 53 Marianne Shaughnessy and Barbara Resnick 4. Restorative Care Activities 74 Robin E. Remsburg 5. Motivating the Older Adult to Engage in Restorative Care 96 Barbara Resnick 6. Documentation and Reimbursement for Restorative Care 112 Annette Fleishell Appendix: The Interdisciplinary Team Approach 139 Marjorie Simpson Index 143 v This page intentionally left blank List of Tables and Figures Table 1.1 Basic Goals of Restorative Care Table 2.1 Overview of an Education Program for Restorative Care Table 2.2 Components of Nursing Assistant Restorative Care Activities Table 2.3 List of Weekly Classes for 6-Week Training Program Table 2.4 Case Examples to Facilitate Discussion During Week One Inservice Training Table 2.5 Incorporating Exercise Into Daily Activities Table 2.6 Methods to Ensure Restorative Care Success Table 2.7 Top 10 Reasons to Incorporate Restorative Care Into Daily Activities Table 2.8 Examples of Long- and Short-Term Goals and Nursing Assistant Approaches Table 2.9 Guidelines for Development of Goals Figure 2.1 Power Point Presentations for Inservice Education Table 3.1 Checklist for Restorative Care Evaluation Table 3.2 List of Functional Scales Table 3.3 Katz Index of ADLs Table 3.4 Instrumental Activities of Daily Living Table 3.5 Barthel Index Table 3.6 Urinary Incontinence Table 3.7 Differences in Signs and Symptoms Between Osteoarthritis and Rheumatoid Arthritis Table 3.8 Evaluation of Falls Table 3.9 Signs and Symptoms of Stroke Table 3.10 Signs and Symptoms of Parkinson's Disease Table 3.11 Characteristics of Dementia, Delirium, and Depression Table 3.12 Typical and Atypical Signs and Symptoms of Depression Table 3.13 Cognitive and Behavioral Measurement Tools Table 3.14 Age-Related Changes in Sleep and the Sleep Cycle Table 3.15 Contracrures Table 3.16 Muscle Strength Grading Table 3.17 Steps for Doing Manual Muscle Testing Table 3.18 Tool to Record Muscle Strength Table 3.19 Gait Disorders Table 3.20 Clock Drawing Scoring Table 3.21 Exercise Definitions Table 3.22 Need for Prescreening of Older Adults for Safe Exercise Table 3.23 Warning Signs to Recognize During Exercise Table 4.1 Goal Attainment Scales Table 4.2 Assistive Devices for ADLs Table 4.3 Components of ADLs Vll Table 4.4 Quality of Feeding Assistance Assessment Table 4.5 Caregiver Behavior Checklist Table 4.6 Recommendations for Grooming and Dressing Classes Table 4.7 Exercise Program for Bedbound, Nonambulatory, and Ambulatory Older Adults Table 4.8 Recommendations for Walking/Ambulation Groups Table 4.9 Recommendations for Well-Attended Group Classes Table 4.10 Group Classes Especially for Those with Cognitive Impairment Table 5.1 Components of the Wheel of Motivation and Specific Interventions to Improve Motivation Table 5.2 Age Changes Related to Motivation Table 5.3 Normal Physiological Changes Associated With Aging Table 5.4 Interventions to Improve Vision Table 5.5 Interventions to Augment Hearing Table 5.6 Strategies to Promote Independent Function in Cognitively Impaired Older Adults Table 5.7 Verbal Encouragement Dos and Don'ts Table 5.8 Identifying Unpleasant Sensations Table 5.8a Checklist for the Presence of Pain Table 5.8b Pain Assessment Table 5.8c Checklist for Evidence of Deconditioning Table 5.9 Pursed Lip Breathing Exercises Figure 5.1 Wheel of Motivation Figure 5.2 Motivational Poster Table 6.1 Activities of Daily Living as Defined by Federal Regulations Table 6.2 Components of Restorative Care Nursing Programs Table 6.3 MDS Requirements for Documentation and Assessment Table 6.4 MDS Version 2.0 Special Treatment and Procedures Table 6.5 MDS User's Manual Definitions of Functional Activities Table 6.6 Restorative Care Flowsheet 1 Table 6.7 Restorative Care Flowsheet 2 Table 6.8 MDS Continence: Appliances and Programs Table 6.9 Definition of Activities Under Scheduled Toileting and Bladder Retraining Programs Table 6.10 CMS Criteria for Nursing Rehabilitation and Restorative Care Table 6.11 Supportive Nursing Documentation for Therapies Table 6.12 Suggestions for Documenting Resident's Inability to Participate in Treatment Table 6.13 Restorative Care Resident Progress Note Table 6.14 Restorative Care Resident Progress Note—Final Documentation Table 6.15 Range of Motion Assessment and Initial Plan: Upper Extremity Table 6.16 Range of Motion Assessment and Initial Plan: Lower Extremity Table 6.17 Functional Assessment Table 6.18 Federally Required Documentation of Restorative Care Activities Table 6.19 Contractures Care Plan Table 6.20 Definition and Requirements of the Care Plan Table 6.21 Essential Components of Care Planning Table 6.22 Resident Behavior Data-Gathering Tool Table 6.23 Sample Documentation for Restorative Care Resident Class Attendance Table 6.24 Documentation for Ambulation Class Attendance Table 6.25 Restorative Care Program Quarterly Summary Table 6.26 MDS Quality Indicators Table 6.27 Clinical Links Among MDS-Based Quality Indicator Domains and Quality Indicators viii Contributors Marjorie Simpson, MS, CRNP, Doctoral Student University of Maryland School of Nursing Baltimore, MD Marianne Shaughnessy, PhD, CRNP Assistant Professor University of Maryland School of Nursing Baltimore, MD Annette Fleishell, RN, BSN Joanne Wilson's Gerontological Nursing Ventures Laurel, MD Robin Remsburg, PhD, APRN, BC Johns Hopkins University School of Nursing Baltimore, MD ix